Common Conditions

Options for Treating Peyronie’s Disease

Jan 26, 2011

If you or your partner have Peyronie’s disease, or penile curvature, you might feel anxious about your treatment options, especially if you need surgery. How do you know if surgery is right for you? What surgical options are available? And what are the common side effects?

Let’s take a look at some of these questions.

Candidates for Surgery

Generally, candidates for surgery are in the stable phase of Peyronie’s disease, which usually starts around 12 months after onset. This means that the condition is not changing. It’s not getting worse, but it’s not improving either. Surgery before this phase may not be as effective.

Also, candidates for surgery must be bothered by their condition. Peyronie’s disease might make intercourse impossible. Or, it might cause pain for the man and/or his partner. It could even prevent men from starting new relationships. In these cases, surgery would likely be the appropriate choice.

Now that we’ve established who is a candidate for surgery, let’s look at the different types of surgical procedures used to treat Peyronie’s disease.

Tunica Albuginea Plication (Nesbit Procedure)

In the penis, the tunica albuginea is the thin outer membrane that covers the spongy chambers that fill with blood during an erection (corpora cavernosa). Scar tissue associated with Peyronie’s disease is found in the tunica albuginea.

In this procedure, the tunica albuginea tissue on the opposite side of the plaque is folded and stitched. This cancels out the curvature and straightens the penis.

Tunica albuginea plication is generally recommended for men who have a curvature of less than 60 degrees with no other deformity, like an hourglass shape, and who can still have a satisfactory erection.

This procedure is considered the simplest surgical option for Peyronie’s disease, with the fewest side effects. Usually, some shortening of the penis occurs. Erectile function and ejaculation are generally preserved.

Plaque Incision and Grafting (Horton-Devine Procedure)

This more complex procedure is recommended for patients with more severe curvature. Plaque incision and grafting involves cutting into the plaque itself. The penis is then straightened and the incision is filled with another material called a graft. The graft can be tissue from another part of your body, like the undersurface of skin or tissue from the testicle lining. Or, it might be tissue harvested from another human or animal. In either case, the replacement tissue is elastic and flexible, making erections easier. (In contrast, the plaque is not elastic, which is why men with Peyronie’s disease have the curvature and pain.)

While both of the above procedures have high satisfaction rates, some patients do experience loss of sensitivity at the tip of the penis, additional curvature, and a continued shortening of the penis. Erectile dysfunction is another possibility, but can be treated with oral medications.

Prosthetic Surgery (Penile Implant)

Prosthetic surgery is usually recommended only for men who have both Peyronie’s disease and erectile dysfunction. A penile prosthesis can both straighten the penis and make it rigid enough for a satisfactory erection.

An inflatable prosthesis is most commonly used. In the procedure, two cylinders are placed in the penis. A reservoir of fluid is placed under the groin muscles and a pump is placed in the scrotal sac.

To use the prosthesis, the man presses the pump. Fluid leaves the reservoir and fills the cylinders, causing an erection. When a man wants the erection to stop, he presses the pump again to deflate the cylinders. The fluid then returns to the reservoir.

While prosthetic surgery for Peyronie’s disease has a high satisfaction rate, there are some risks. The prosthesis can leak and/or become infected. There can also be mechanical malfunctions and other problems with curvature.

Which Procedure is Right for You?

Only your doctor can help you decide this. Much will depend on the staging of your condition and the degree of discomfort it’s causing. No matter which procedure is used, be sure to see a qualified surgeon who is experienced in penile surgery and performs these surgeries regularly.

Keep in mind that not all men with Peyronie’s disease require surgery. In some cases, penile pain subsides and the curvature is not enough to be bothersome or to prevent intercourse.